Milestone 8 Update HEAT T10 Business Meeting 30 th March 2010 - - PowerPoint PPT Presentation

Milestone 8 Update HEAT T10 Business Meeting 30th March 2010

Yvonne McCallion Integrated Admission and Discharge Manager NHS Fife

Patients Referred To And / Or Seen By Mental Health Team In A&E By Month 01/01/2009 – 31/12/2009

10 20 30 40 50 60 70 J a n u a r y F e b r u a r y M a r c h A p r i l M a y J u n e J u l y A u g u s t S e p t e m b e r O c t

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e r N

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e m b e r D e c e m b e r Month of Attendance Number of Patients Seen by Psychiatry 50 100 150 200 250 300 Average Length of Stay in A&E VHK QMH VHK QMH 4 Hours

Patients Referred To And / Or Seen By Mental Health Teams In A&E By Hour 01/01/2009 - 31/12/2009

5 10 15 20 25 30 35 40 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 Hour of Arrival Number of Patients Seen by Psychiatry VHK QMH

10 20 30 40 50 60 70 80 90 Monday Tuesday Wednesday Thursday Friday Saturday Sunday Day of Arrival Num ber of Patients Seen by Psychiatry VHK QMH

Patients Referred To And / Or Seen By Mental Health Teams In A&E By Day 01/01/2009 - 31/12/2009

Referral Source Of Patients Referred To And / Or Seen By Mental Health Team 01/01/2009 – 31/12/2009

0.0% 10.0% 20.0% 30.0% 40.0% 50.0% 60.0% Emergency Services Self Referral Nhs 24 Other Hospital General Practitioner Gp Out Of Hours Service - Pces Other Ward Or Dept, Vhk Victoria Hospital, Kdy - A&E Dept Other Ward Or Dept, Qmh VHK QMH

0.0% 5.0% 10.0% 15.0% 20.0% 25.0% 30.0% 35.0% Discharged - With Referral Admitted Discharged - With Follow Up by Primary Team Discharged - No Follow Up Transferred Incomplete - Patient Left Before Assessment Completed Incomplete - Patient Left After Treatment Started Incomplete - Patient Left Before Being Treated Incomplete - Patient Refused Treatment Other Incomplete - Patient Removed by Police VHK QMH

Outcome Of Patients Referred To / Seen By Mental Health Team 01/01/2009 - 31/12/2009

Number of Patients in A&E Seen by or Referred to Psychiatry by Age Group 01/01/2009 - 31/12/2009

20 40 60 80 100 120 140 160 4 & Under 5-14 15-24 25-34 35-44 45-54 55-64 65-74 75 & over VHK QMH

Improve Mental Health Liaison And Addiction Services

From May 2010:

• Involve mental health clinicians and managers in A&E breach analysis for core sites,

concentrating initially on sites with difficulty sustaining 98% compliance Current Arrangements

• Mental health breaches sent weekly to local mental health teams
• Within mental health – named lead for 4 hour emergency access standard
• Mental health lead participates in 4 hour emergency access pathway groups
• A&E Consultant meets with mental health and A&E staff to look at process

Challenges / Future Actions

• Breach analysis undertaken by A&E staff – some disagreement from mental health / inaccuracy

around breach causes

• No lead identified as yet for T10
• Mental Health Doctor engagement

Mental Health Patients – Performance Against 4 Hour Emergency Access Standard

Number of Patients Referred to Psychiatry Number of Psychiatry Breaches % compliance with 4 hour target Number of Patients Referred to Psychiatry Number of Psychiatry Breaches % compliance with 4 hour target November 38 1 97.4% November 54 1 98.1% December 42 3 92.9% December 27 4 85.2% January 40 1 97.5% January 39 3 92.3% February 35 100.0% February 41 5 87.8% VHK QMH

Improve Mental Health Liaison And Addiction Services

From May 2010

• Agree and work towards implementation of mental health quality standards for the time taken to

assess A&E attendees Current Arrangements

• As part of Emergency Access pathway group work, A&E are seeking to develop service level

agreements with specialties and services to support achievement of the 4 hour emergency access standard – mental health included

• Introduction of mental health Unscheduled Care Team in July 2009 – time standards considered

at that time but abandoned

• Improvements in mental health response times to A&E since introduction of Unscheduled Care

Team

• Now - early discussions between A&E and mental health around development of mental health

standards for A&E Challenges / Future Actions

• Reluctance from mental health teams to agree mental heath quality standards ‘until issues

around consistent breach analysis are resolved’

• Availability of national mental health quality standards – current guidance refers to England and

Wales only ‘Managing Urgent Mental Health Needs in the Acute Trust – Academy of Medical Royal Colleges (2008)’

• No local mental health team awareness / acknowledgement of drive by SG and Scottish division
• f Royal College of Emergency medicine to introduce such standards – although resistance by

Royal College of Psychiatry

Improve Mental Health Liaison And Addiction Services

From May 2010

• Review local arrangements for alcohol services including alcohol liaison service to core sites,

and speed of access to community alcohol services after A&E attendance Current Arrangements

• 2 year fixed term programme of alcohol brief interventions in A&E
• Completion of screening tool for all patients over 16 years
• Alcohol liaison nurse presence in both A&E sites (Monday to Friday 0900-1700hrs)
• Referral to addiction services by alcohol liaison nurse if required
• Out of hours - appointments made for patients by A&E staff
• A&E staff training around screening
• Addiction services teams working towards HEAT target A11 – ‘local’ target by December 2010

that everyone accessing drug and alcohol service will have a comprehensive assessment undertaken within 4 weeks of referral Challenges / Future Actions

• Risk of increase in non – emergency alcohol related attendances to A&E
• What happens at end of 2 year period? NHS 24?

Improve Mental Health Liaison And Addiction Services

From May 2010

• Review mental health service provision for core sites by age bands
• Review alternative (i.e. out of hospital) urgent mental health service provision with a specific

focus on Monday-Sunday 0900 – 2100 Current Arrangements

• Since July 2009 Unscheduled Care Team - single point of access for all mental health services

24 hours a day on core sites

• Initial assessment by nurse with exception of paediatric referrals
• Improved accuracy of signposting to appropriate mental health ‘subspecialties’ and external

agencies by Unscheduled Care Teams Challenges / Suggested Future Actions

• Requirement to scope mental health services, e.g. in hours / out of hours, age band of patients

treated, mental health ‘sub specialities’, source of referrals for each service, referral route to each service

• Requirement to further analyse mental health attendances to identify existing links with mental

health services, availability of these services and the rationale for attending A&E

Additional Actions

• Analysis of NHS 24, PCES and GP ‘mental health referrals’ to A&E – why not direct emergency

referrals to mental health?

• Highest number of patient outcomes for patients seen by / referred to mental health is discharge

with referral – requirement to analyse where the referrals are to and whether there could not be direct access to them by particular referrers avoiding A&E

• Understanding why peak numbers of patients present between 1800-1900hrs
• Understanding why the peak days are Sunday and Monday
• Are presentations different at weekends and weekdays? – link to availability of mental health

services